Alcoholism: Is It a Disease?

Given the narrowness of Jess Money's definition of disease (Letters, Sept. 21), it's not surprising that it excludes alcoholism. But like all oversimplification it fails.

Like Money, we tend to believe that disease is something you "catch." On the contrary, many disease-causing bacteria live within us benignly. The bacteria Escherichia coli , for example, flourishes in the intestinal tract, often without causing disease. But under just the right circumstances, E. coli can cause gastrointestinal and urinary tract disease. Yet, this bacteria is not "caught"; it's always present.

Money also defines disease as a "byproduct of normal, innocent activity." On the other hand, alcoholism is something "you buy." Lung cancer can also be bought, but that doesn't negate the reality of this disease. In other, subtler ways we also contribute to our disease. By stressing our bodies--staying up late, not eating right--we leave ourselves more susceptible to disease, and therefore partly responsible.

Money says alcoholism is not a disease because it cannot be "excised like a tumor, casted like a broken bone, or destroyed by antibiotics." Alcoholism isn't the only disease that cannot be handled by traditional medical treatment: ribs cannot be casted, even the common cold cannot be treated with antibiotics. And as for excision, no, you can't excise alcoholism because it's a disease of the whole person, to a greater degree than most. It is as deeply entrenched in the mind and spirit as it is in the body.

This makes it a far more complex disease to understand and treat.

If we accept Webster's definition of disease as "an alteration of the living body that impairs its functioning," then alcoholism qualifies. This does not imply that alcoholics haven't contributed to their own disease. No, of course not. But alcoholism isn't simply the act of drinking to excess, just as lung cancer is more than the inhalation of carcinogens. The predisposition to disease is the foundation of disease: Not everyone who smokes develops cancer, not everyone who drinks becomes alcoholic.

The most baffling aspect of alcoholism is the victim's seemingly willing participation in his illness. Where cancer can evolve in the absence of tobacco, alcoholism requires alcohol.

To see an alcoholic in the throes of disease is like watching someone walk headlong in freeway traffic at rush hour. It looks like insanity, and it is; insane because it's a disease that denies its own existence.

When a man learns he has cancer we expect him to deny it at first. We don't think that madness because we believe it will eventually give way to acceptance. Alcoholics generally spend much longer denying their disease. The excuses can last a lifetime.

Alcoholism has been described as an allergy of the body coupled with an obsession of the mind. So not only does biology predispose alcoholics to disease, but also the less tangible things that happen between the ears. It's not as tidy as a broken arm, or a strep throat, or skin cancer, but that doesn't mean we abandon it. Instead we need to expand our understanding, look a little deeper.

Why all this fuss about semantics? What difference does it make if alcoholism is a disease or not? Let me belabor one last point from Money's letter: the issue of whether alcoholism ceases when the alcoholic stops drinking. If that's the case I stopped being an alcoholic nine years ago. But I don't believe that to be true. To treat it as something that could simply be assailed with my unaided will means that no further action need be taken when I stopped drinking. It doesn't work.

Not only did I need support, in order to insure my reprieve I've had to do some serious housecleaning, face up to my past, make restitution, in addition lending my own hand to other struggling alcoholics. You see, my body began to repair itself when the alcohol was gone; my mind and spirit require treatment, even now. Unlike other diseases, it never goes away. Admitting that I was an alcoholic wasn't a means to excuse my past behavior. It was simply a starting point, one that saved my life.